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In this 12-week randomized trial comparing two biologic agents known to be effective for psoriasis, ustekinumab (an interleukin-12 and interleukin-23 blocker) was more effective than etanercept (an inhibitor of tumor necrosis factor α). Adverse events associated with the two treatments were similar, but the trial was not large enough and follow-up was not long enough to assess uncommon adverse events.
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Preoperative biliary drainage is often performed in patients with obstructive jaundice caused by cancer of the pancreatic head, but the benefit of the procedure is unclear. This randomized trial compared 4 to 6 weeks of preoperative biliary drainage, followed by surgery, with immediate surgery alone for cancer of the pancreatic head. The drainage procedure increased morbidity and did not decrease the rate of surgical complications.
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A donor trachea, harvested from a cadaver, was transplanted into the forearm of a recipient and wrapped in the recipient's fascia. Months later, a vascular supply to the allograft had become established, and the tracheal epithelium had repopulated with a buccal mucosa graft from the recipient. Immunosuppressive therapy was stopped, and the allograft was used to repair the recipient's tracheal defect. The graft continues to function more than 1 year later.
Nosocomial bacterial meningitis is most often related to either complicated head trauma or invasive procedures, such as craniotomy, placement of ventricular catheters, intrathecal infusion of medications, or spinal anesthesia. In addition, metastatic infection from hospital-acquired bacteremia occasionally leads to meningitis. The conditions are associated with different pathogenetic mechanisms and a different spectrum of microorganisms, and therefore the choice of empirical antimicrobial therapy will vary according to the condition.
A 75-year-old man was admitted to this hospital because of the recent onset of hypertension, hyperglycemia, and edema. He had a history of prostate cancer, hemochromatosis, adrenal and thyroid nodules, and colonic polyps. The white-cell count was 17,400 per cubic millimeter with 87% neutrophils; the serum level of potassium was 2.6 mmol per liter and chloride 97 mmol per liter. Imaging studies showed pulmonary and hepatic nodules that had not been present on earlier studies. A diagnostic procedure was performed.
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